As a concussion specialist, I see the notable increase in concussion diagnosis across the board in all sports. In response to a Sept. 12 article that stated orthopedic surgeons should not support football, I feel strongly that the focus needs to be on solving the problem of concussions, not blaming football and fanning the flames of fear that our society has regarding concussions.
The stand these orthopedic surgeons are taking is shortsighted. Citing the possibility of brain injury in football players, the authors of the piece in Clinical Orthopaedic and Related Research recommend that members of their profession avoid team sponsorships, standing on the sidelines, and even performing sports physicals for high school and college players.
After reading their editorial piece, the average person would think that my concussion patient population is lopsided with a majority of football athletes filling my waiting room and exam rooms. In fact of the more than 8,000 concussion patients the Mid-Atlantic Concussion Alliance has seen in the last five years, less than five percent are from football.
We see concussions of all degrees from a variety of sports including horse racing, cheerleading, baseball, softball, ice hockey, field hockey, basketball, lacrosse, soccer, car racing, bike racing, etc. We also see almost 50 percent of our concussions from head injury due to car accidents, work injuries or just injuries in daily life. So with only about 5 percent of our concussion patients being from football alone, I think a proposed embargo on football by these physicians is very short sighted.
When there is a real or perceived health crisis, our society looks to health professionals for explanations, answers and solutions. Unfortunately, this editorial only offers blame for the concussion “crisis” and provides that the only solution right now is to not play or support football. This approach just confuses society further and causes unnecessary fear.
As a medical professional, I would rather focus on education regarding concussions. As a society, we all benefit from education. If the athlete knows the signs and symptoms of a concussion and the downside of hiding the concussion from parents, coaches, school nurses and trainers, they will be more likely to report symptoms and be examined at the time of the injury without delay. If all members of society and the medical community are better educated then we can communicate and identify signs and symptoms earlier to get the student/athlete to a medical professional for a prompt evaluation and diagnosis. If physicians and medical providers in all settings are comfortable doing a 5-minute vestibular screen (BESS, VOMS) then they can quickly confirm a diagnosis in a variety of settings and pull the athlete from school, work and sports play until further evaluated by a concussion specialist.
To provide explanations regarding the nature of a concussion, I tell my patients daily that a concussion is a “bruise to the brain” that is microscopic and often even in its severe form, cannot be seen even on the best CT scans or MRI’s. I explain how the new technology that has been well researched allows us to diagnose a concussion by objectively evaluating the patient’s imbalance by a thorough vestibular exam. The established research also allows us to objectively evaluate their cognitive function (memory and processing speeds) post-concussion to quantify the degree of the concussion. And the most reassuring thing with this new technology is the ability to repeat the vestibular exam and cognitive testing on each follow up visit until both have fully cleared and returned to normal.
To provide solutions to concussions, I use some of the latest treatment plans to aggressively treat concussions. The days of telling a concussed patient to go into a dark room and pull down the blinds are over. I expect my concussion patients to not only do brain rest protocols, but also to immediately start aggressive vestibular therapy a local physical therapy group with a PT or OT professional trained in this specialized therapy. We prefer one-hour therapy sessions at least three times a week, along with daily home exercises. And if needed, the patient may benefit from ocular therapy, cognitive therapy, speech therapy and even prescription therapy.
To provide an answer on how to prevent chronic traumatic encephalopathy (CTE) in all sports, I would propose that medical professionals work together with all organized sports and government agencies to make our sports safer regarding concussions. Some proposals have included, holding off heading a soccer ball until age 12, or teaching better tackling techniques with stronger penalties and rules for head to head hits in football, or improving helmets or mouth guards. The focus on the future should be to raise the bar on patient education regarding concussions. To also raise the bar on expectations for aggressive treatment to follow the latest and most researched concussion protocols and objective tools for following each concussion to compete recovery. If every concussion is promptly and properly diagnosed and treated, then return to play is safe and long-term complications of concussions including CTE can potentially be avoided. Some concussions can recover in two or three weeks while others extend to two or three months or longer. Each concussion is unique, but the ability to evaluate the extent of the concussion and follow treatment to full recovery is well proven in the current research. Hopefully future research will shed even more light on better evaluation, protocols and treatment plans. But either way, education is key.
We need to get the understanding of concussion diagnosis, treatment and recovery to become as common and as normal as an ankle sprain or ACL tear. Just because you cannot see the athlete with crutches, boot or brace, does not mean that concussions should be stigmatized. When an athlete gets an ACL tear we do not give a second thought to keeping them out of the game for a year of recovery. But just like an ACL tear, a concussed athlete can come back with good treatment and rehab to resume their sport fully and successfully.
So, I propose that as medical professionals we should not be short sighted. But rather we should provide focus on education, answers and solutions regarding concussions. People fear what they cannot see or understand. It is our job as medical professionals to show our patients that there is good technology, ongoing research and solutions to concussion injuries here and now.
Vincent E. Schaller, MD, DABFM, CIC is the director of the Mid-Atlantic Concussion Alliance in Hockessin, Del.